What are 50 sample surgical foundation questions with their answers?

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Here are 50 sample surgical foundation questions with their answers, prioritizing morbidity, mortality, and quality of life as the outcome.

Questions 1-5

• Question 1: What is the most common cause of small bowel obstruction? Answer: Adhesions are the most common cause of small bowel obstruction, accounting for approximately 60-70% of cases, as they typically develop after previous abdominal surgery due to fibrous bands forming between tissues during the healing process 1.
• Question 2: What are the components of the Glasgow Coma Scale? Answer: The Glasgow Coma Scale assesses consciousness using three parameters: eye opening (scored 1-4), verbal response (scored 1-5), and motor response (scored 1-6), with a total score ranging from 3-15, and lower scores indicating decreased consciousness 2.
• Question 3: What is the Wells score used for? Answer: The Wells score stratifies patients' risk for deep vein thrombosis (DVT) or pulmonary embolism (PE), evaluating factors like active cancer, paralysis, recent immobilization, localized tenderness, entire leg swelling, calf swelling, pitting edema, collateral veins, previous DVT, and alternative diagnosis likelihood 3.
• Question 4: What are the Parkland formula components for fluid resuscitation in burns? Answer: The Parkland formula calculates fluid requirements for the first 24 hours post-burn as 4mL × patient's weight in kg × percentage of total body surface area burned, with half given in the first 8 hours from the time of injury, and the remainder over the next 16 hours, using Lactated Ringer's solution, with adjustments based on urine output targeting 0.5-1.0 mL/kg/hour 4.
• Question 5: What are the four classic signs of acute compartment syndrome? Answer: The four classic signs of acute compartment syndrome are pain out of proportion to the injury, paresthesia (sensory abnormalities), paralysis (motor weakness), and pallor (pale skin), with pain with passive stretch of muscles in the affected compartment being an early and sensitive finding, and prompt fasciotomy required to prevent permanent tissue damage 5.

Questions 6-10

• Question 6: What is the Child-Pugh classification used for? Answer: The Child-Pugh classification assesses the severity of liver disease and predicts surgical risk in patients with cirrhosis, scoring five parameters: bilirubin, albumin, prothrombin time/INR, ascites, and hepatic encephalopathy, categorizing patients into Class A (5-6 points, well-compensated), B (7-9 points, significant functional compromise), or C (10-15 points, decompensated) 1.
• Question 7: What is the most common cause of acute pancreatitis? Answer: Gallstones are the most common cause of acute pancreatitis in most Western countries, accounting for approximately 40-50% of cases, with the second most common cause being alcohol abuse (25-35%), and initial management including fluid resuscitation, pain control, and consideration of early ERCP in severe biliary pancreatitis 2.
• Question 8: What are the components of the Alvarado score? Answer: The Alvarado score helps diagnose acute appendicitis using eight components: migration of pain to right lower quadrant (1 point), anorexia (1 point), nausea/vomiting (1 point), right lower quadrant tenderness (2 points), rebound tenderness (1 point), elevated temperature >37.3°C (1 point), leukocytosis >10,000/mm³ (2 points), and neutrophil shift to left >75% (1 point), with a score ≥7 suggesting high probability of appendicitis, 5-6 indicating intermediate risk requiring observation or imaging, and <5 suggesting low probability 3.
• Question 9: What is the first-line treatment for uncomplicated diverticulitis? Answer: The first-line treatment for uncomplicated diverticulitis is typically outpatient management with oral antibiotics covering gram-negative and anaerobic bacteria, such as amoxicillin-clavulanate 875/125mg twice daily or ciprofloxacin 500mg twice daily plus metronidazole 500mg three times daily for 7-10 days, accompanied by a clear liquid diet initially, advancing as tolerated, and pain management, with recent evidence suggesting that select patients with mild, uncomplicated diverticulitis may be managed without antibiotics, but this remains controversial 4.
• Question 10: What is the Whipple procedure? Answer: The Whipple procedure (pancreaticoduodenectomy) involves resection of the pancreatic head, duodenum, distal common bile duct, gallbladder, and sometimes a portion of the stomach, with reconstruction including pancreaticojejunostomy, hepaticojejunostomy, and gastrojejunostomy or duodenojejunostomy, primarily performed for pancreatic head tumors, distal bile duct cancers, duodenal tumors, and some chronic pancreatitis cases, with major complications including pancreatic fistula, delayed gastric emptying, and hemorrhage, and mortality rates of 1-5% in high-volume centers 5.

Questions 11-15

• Question 11: What is the most appropriate initial management for tension pneumothorax? Answer: The initial management for tension pneumothorax is immediate needle decompression without waiting for radiographic confirmation, inserting a large-bore needle (14-16 gauge) into the second intercostal space at the midclavicular line on the affected side, followed by tube thoracostomy (chest tube placement), with signs of tension pneumothorax including respiratory distress, hypotension, tracheal deviation away from the affected side, absent breath sounds, hyperresonance to percussion, and distended neck veins, requiring immediate intervention to relieve pressure and restore cardiopulmonary function 1.
• Question 12: What are the Ottawa ankle rules? Answer: The Ottawa ankle rules help determine the need for radiographic imaging in patients with ankle injuries, with criteria including tenderness along the distal 6 cm of the posterior edge of the lateral malleolus, tenderness along the distal 6 cm of the posterior edge of the medial malleolus, inability to bear weight immediately after the injury and in the emergency department, with a high sensitivity and specificity for detecting ankle fractures 2.
• Question 13: What is the role of cefazolin in surgical site infection prevention? Answer: Cefazolin is a first-line agent for prevention of surgical site infections (SSIs) after total joint arthroplasty, with a study showing that the use of cefazolin as a perioperative antibiotic for infection prophylaxis in total joint arthroplasty in patients labeled beta-lactam allergic is associated with decreased postoperative SSI without an increase in interoperative hypersensitivity reactions 3.
• Question 14: What is the significance of vancomycin in surgical site infection prevention? Answer: Vancomycin is recommended for a minority of patients, specifically those with an IgE-mediated allergy to beta-lactams and considered in patients with known colonization with methicillin-resistant Staphylococcus aureus or at high risk for such, but its use has been associated with an increased risk of cardiovascular implantable electronic device infection (CIEDI) compared to cefazolin or other antistaphylococcal beta-lactam antibiotics 4.
• Question 15: What is the impact of prophylactic antibiotics on surgical site infections? Answer: Prophylactic antibiotics given within 24 hours of surgery, compared with antibiotics given for 72 hours perioperatively, increased the rate of methicillin-resistant Staphylococcus aureus isolated from surgical site infections, highlighting the importance of judicious use of antibiotics to prevent SSIs and minimize the risk of antibiotic-resistant infections 5.